Healthcare Provider Details

I. General information

NPI: 1083844567
Provider Name (Legal Business Name): ANDREA K WEIKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 LYNDALE AVE S SUITE 201
MINNEAPOLIS MN
55408-2171
US

IV. Provider business mailing address

2227 FOREST DR NE
COLUMBIA HEIGHTS MN
55421-2016
US

V. Phone/Fax

Practice location:
  • Phone: 612-879-8000
  • Fax: 612-879-8778
Mailing address:
  • Phone: 612-388-5237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN654134053215
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: